Denosumab-related osteonecrosis of the jaw: A literature review

Abstract

Osteonecrosis of the jaw (ONJ) is a rare treatment-related side effect of anti-resorptive drugs whose risk is increased by concomitant local and systemic factors. The number of cases of medication-related ONJ is constantly increasing as a result of the rising tide of molecular-targeted and immunological drugs used in cancer treatment. Denosumab-related ONJ presents peculiar pathophysiological, histopathological, clinical, and therapeutic features compared to that induced by bisphosphonates-related ONJ. This study aimed to compare ONJ induced by denosumab to that caused by bisphosphonates. We have reviewed the literature of the last 5 years on denosumab-related ONJ, focusing on reviews and meta-analyses. The physiopathology of ONJ is unclear. Denosumab acts on receptor activator of nuclear factor kappa-B ligand (RANKL) to inhibit the formation and activity of osteoclasts. The reduction of bone turnover seems to play an important role. Dentists and oral surgeons in the coming years will see an increasing number of patients who are receiving treatment potentially toxic to bone, but also require good dental care. Early recognition of ONJ is essential in the patient’s treatment with denosumab, therefore a close collaboration between the dentist and oncologist is fundamental.